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Monday, August 03, 2020

Epilepsy Treatment Gap: The Role of the 21st Century Medical Doctor

Written by: Muoka Chibuzor G BSc, MBBS(in view)

Humanity is battling with lots of diseases. While some of these diseases have been eradicated to the barest minimum, a few of which includes Epilepsy have persisted from the days of yore till this modern era due to many factors of which are within and beyond the ambits of human control. Millions of people worldwide have epilepsy but are predisposed helplessly to its debilitating effects due to an obstacle called the “treatment gap” which lies between the patients and their treatments.

Epilepsy is as old as history, and was believed to be a supernatural affliction that requires a spiritual antidote. 2000 years ago, epilepsy was believed to be caused by evil spirits and infectious. Questions arose from all walks of life asking; “Why would an individual suddenly fall unconsciously and then the muscles stiffens with immediate jerky movements of the limbs (convulsion); isn’t such a person possessed by evil spirits?” However, a revolutionary view came up as Hippocrates the father of western medicine declared that men who think epilepsy is divine, merely do so because they do not understand it.

In the 19th century, John Hughlings Jackson a London neurologist stated that, “seizures were the result of excessive sudden brief electrochemical discharges of energy in the brain. And the character of the seizure depends on the location and function of the seat of the discharges.” Advancements in neuroscience coupled with the incorporation of the electroencephalogram (EEG), demystified the mysterious epilepsy; and it was understood to be a neurological condition which affects the nervous system (the brain), and presents physically in various forms. It is only diagnosed when a person has had at least two seizures that were not part of another medical condition.

Apart from idiopathic conclusions, further research came up with the possible causes of epilepsy of which includes age predisposition, genetic influence, head trauma (accidents), stroke, infectious diseases, and brain tumours. The treatment plans of which includes anti-epilepsy drugs e.g., phenobarbitone administration, and neurosurgery helped to restore hope in epilepsy patients who felt cursed because of the incurable nature of epilepsy, the hindrances it brings, and societal stigma associated with it. Indeed, the economic, social, and health demands of epilepsy on the individual, family and the society are immense.

Evidence abound that Africa with a population of 1.2 billion people records the highest cases of Epilepsy. Nigeria the most populous country in Africa is not spared from the grips of epilepsy as statistics shows that the epilepsy treatment gap which refers to the number of people with epilepsy, who need treatment but do not get it have been widened due to certain factors of which stems from the patient, doctor, and society. The patients contribute to the treatment gap when they do not see need to seek treatment, prefer spiritual rituals, are afraid of drug side effects, seeks alternative-ineffective medicines, are battling with the cost of treatment and travel, and have given-up on themselves. The doctor also contributes when there is error in the diagnosis and treatment plan. On the part of the society, the height of stigmatization, ridicule and disenfranchisement dashes the hopes of epileptic patients.

Standing in the shoes of an optimistic neurologist, there is a strong positive indication that the epilepsy treatment gap can be made as narrow as the eye of a needle. This can be achieved by firstly sensitizing the society through the media to understand that epilepsy is simply an illness of the brain and is not something to be ashamed of, neither is it an evil possession or any supernatural phenomenon. It’s just a common illness like malaria or pneumonia that requires only medical attention. Secondly, encouraging the government, non-governmental organizations (NGOs) and influential Individuals to amalgamate and involve fully in the Purple Day – March 26th, whereby funds are made available via contributions to assist epilepsy patients, fund research on epilepsy, and debunk myths about epilepsy. Thirdly, the patients are encouraged upon being diagnosis of epilepsy to accept their fate and embrace the palliative treatments with optimism. Advices are given with emphasis laid on being sensitive to seizure auras, avoiding epilepsy seizure triggers e.g., bright lights, television, hypoglycaemia; and avoiding Irregular intake of drugs as it can make epilepsy to become refractory thereby prolonging the treatment plan.

In conclusion, epilepsy is a very common problem in the world. Anyone can be affected irrespective of the social status. Thus, the need to bridge the epilepsy treatment gap with proactive and palliative actions can help restore the threatened dignity of epilepsy patients.

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